The principles and practice of medicine / [John Elliotson] ; edited by Nathaniel Rogers and Alexander Cooper Lee.

  • John Elliotson
Date:
1842
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of medicine / [John Elliotson] ; edited by Nathaniel Rogers and Alexander Cooper Lee. Source: Wellcome Collection.

    26/1242 page 6
    den starting from sleep to the waking state, a small and intei mittmg pu se, cold extremities, and swollen feet. The remedies of hydiot miax may appear indicated; hut the ear will discover, on percussion, a ho ow soun far too hollow a sound—in the chest, at its very lowest parts, v\ 11 e t leie is, in the first case, little respiratory murmur, and in the seconc none a all,—at the very place where the hollow sound is heard. Nothing u le ear can show the nature of these cases. Nothing but the eai can ls^n guish them from each other. Without the ear, no case can he known witr certainty to be one of hydrothorax,—however marked the symptoms. . . It has more than once happened to me, to be unable to form any opinion as to the nature of a disease, without auricular examination. Patients have complained of mere debility and loss of flesh, with slight geneia ailment; and have declared themselves free from all local symptoms. so that nothing but the most random guess could be made at their disease. A minute examination of them has discovered nothing wrong, or nothing materially wrong, in the performance of the functions of the head, chest, or abdomen : but, on percussing the chest, the sound proved as dead in some part as if the thigh had been struck; and, applying the stethoscope, no respiration has been heard, or the voice has rushed through the instru- ment, or an unnatural sound has been heard in the heart; and thus the whole mystery has been at once cleared up. In truth, the exact state ol the functions of the lungs and heart cannot be ascertained, except by the ear; and without an examination by its aid, no one is warranted in de- claring these functions healthy. I onCe admitted a man into St. ihomass Hospital, without any friend to give an account of him; and so deaf and stupid, that he could scarcely give any himself. He complained merely of occasional coldness, heat, and sweating, with debility ; declared he had been ill but two or three weeks; and ascribed his complaint to sleeping in a damp bed at Gravesend. The case resembled remittent fever more than any thing else; and I treated it with sulphate of quinine. The symptoms of remittent fever yielded; but the debility remained, and even increased. I investigated the case minutely. There were no symptoms of phthisis, or of any other local disease, except convexity of the nails; but, on striking the chest, I found the right superior part give a dead sound; and in the centre of this I heard pectoriloquism. The case was then regarded as one of abundant tubercular deposition in the right lung, with an excavation in its centre; and the autopsy showed that the diagnosis was correct. The diagnosis, it is true, did not lead to a cure; but it prevented me from plaguing the patient with medicines, from an erroneous idea of the nature and seat of the disease; and it enabled me to give a correct prognosis. Even when there can exist no doubt in the mind of an able practitioner, as to the scat and nature of the disease, auscultation may prove a useful aid. In consultation, another practitioner, from a peculiar bias towards the heart, may consider the symptoms to arise from that organ; although they arc evidently pulmonic, perhaps even phthisical; and vice versa. Or perhaps he may refer unquestionable symptoms of organic pectoral disease in gene- ral, to the liver, or the digestive organs (according to the reigning folly of the day) ; as is done, continually, with affections of the head and spine. It may be impossible clearly to refute him by the ordinary means of dia»- live and dative of nlpa (blood) are ctlpa.ro;. Indeed, we already have “ pneumatompho- uipari. The genitive and dative of -rnvpa. los , to signify a person with an umbilical (air) are <7rnvpa.ro;,Tnvpttn ; and the com- hernia; and, what is still closer, we have pound word should be “pncumato-{\\ova.x. the word “ pneumatocele.
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